Immunotherapy in children with allergic asthma: Effect on bronchial hyperreactivity and pharmacotherapy

doi:10.1016/S0091-6749(99)70232-0

Journal of Allergy and Clinical Immunology

Volume 103, Issue 4, April 1999, Pages 609-614

https://doi.org/10.1016/S0091-6749(99)70232-0 Get rights and content

Abstract

Background: Immunotherapy has been shown to reduce allergen sensitivity to allergens such as cat and dust mite. The aim of this study was to investigate the effect of cat or dust mite immunotherapy on bronchial hyperreactivity and the need for inhaled corticosteroids in children with asthma, cat or dust mite allergy, and hay fever. Subjects: Twenty-nine children, 7 to 16 years old, completed the 3-year study. They were randomly allocated to receive cat/dust mite or placebo and birch/timothy immunotherapy. Methods: Before immunotherapy was begun and then once each year, bronchial histamine challenges were performed. Bronchial allergen challenge with the perennial allergen was done before and after the 3-year study. Pharmacotherapy was given according to a standardized protocol. Results: PC₂₀ allergen increased significantly in both the active immunotherapy group (P < .001) and in the placebo-pollen group (P < .05). PC₂₀ histamine increased continuously in the active immunotherapy group (P < .05 and P = .002 after 1 and 3 years, respectively) and had also increased after 3 years in the placebo-pollen group (P < .05). The difference between the 2 groups was significant for PC₂₀ allergen (P = .001) but not for PC₂₀ histamine. There was no significant change in the dose of inhaled budesonide needed for symptom control in either of the groups. Conclusion: Pollen immunotherapy combined with inhaled corticosteroids results in improvement of both cat/dust mite bronchial sensitivity and hyperresponsiveness to histamine. The combination of cat or dust mite, pollen immunotherapy, and inhaled budesonide enhances this improvement. Cat immunotherapy also induces cat allergen tolerance. (J Allergy Clin Immunol 1999;103:609-14.)

Section snippets

Subjects

Thirty-eight children were recruited. Four children (2 children with dust mite allergy and 2 children with cat allergy) changed their mind about participating in the study for personal reasons at the first visit after randomization. One child had been randomized without fullfilling the inclusion criteria and was excluded at the start of the study, as was another child who had a bicycle accident before starting therapy. Thirty-two children (age range, 7 to 16 years; mean, 11.5 years) were

Patients

Twenty-nine children completed the 3-year study period. Three children dropped out, 2 children from the active group and 1 child from the placebo group. One child allergic to cat allergen in group A dropped out because of systemic side-effects of immunotherapy. The other dropped out for reasons not related to the study, including 1 of the children from group A allergic to dust mite allergen. Data for the children are presented in Table I.

Immunotherapy

All but 3 patients reached the targeted maintenance dose

DISCUSSION

In this study we found a general reduction in the severity of asthma after 3 years of immunotherapy, combined with regular treatment with inhaled corticosteroids. We have previously reported that cat immunotherapy in patients with mild asthma, mostly without corticosteroid therapy, favorably affects both BHR and bronchial sensitivity to allergen.³ The development of BHR during immunotherapy was similar in this study of children with more severe asthma, and there was a continuous decrease in

Acknowledgements

We thank Ella Allheim, RN, for her excellent assistance.

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Bronchial asthma remains one of the most common chronic diseases with a high degree of morbidity and still a considerable mortality with an increasing prevalence in many countries. Although remarkable progress has been made in the past decades in the medical treatment for asthma, curative or disease modifying approaches are still limited to allergen immunotherapy (AIT). Despite a plethora of potential immunological actions observed during AIT, the precise mechamisms that might exert beneficial effects especially in asthma remain unclear. Clinical studies in the past have suggested clinical benefits in symptom control and medication use with a small reduction in allergen-specific and non-specific bronchial hyperresponsiveness but these results were mainly derived from small, frequently suboptimally designed studies which were poorly comparable. Only recently have larger, dose ranging studies with well standardized allergens with patient relevant endpoints such as corticosteroid requirements for asthma control or the onset of exacerbations following inhaled corticosteroid (ICS) withdrawal corroborated the potential clinical effects of AIT in asthma, suggesting that it might replace some of the controller effects of ICS. In addition, newer, up-do-date designed studies support previous data that in patient populations at risk to develop asthma AIT might have a role in secondary prevention. Further studies on the long term effects as well as comparative studies are needed to further corroborate the role of AIT in the prevention and the control of asthma are needed.
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increase in PC20 to histamine90; increase in PC20 to cat and house dust mite allergens17,90; decrease in the risk of asthma8,9,132-134,190;

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^☆: Supported by ALK, Horsholm, Denmark, and by grants from the Swedish Asthma and Allergy Association.

^☆☆: Reprint requests: Gunilla Hedlin, MD, Department of Pediatrics, Huddinge University Hospital B57, Karolinska Institutet, S-141 86 Huddinge, Sweden.

^★: 0091-6749/99 $8.00 + 0 1/1/95541

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Immunotherapy in children with allergic asthma: Effect on bronchial hyperreactivity and pharmacotherapy☆,☆☆,★

Abstract

Section snippets

Subjects

Patients

Immunotherapy

DISCUSSION

Acknowledgements

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Natural history of bronchial asthma in childhood: a prospective study from birth up to 12-14 years of age

Allergy

Growth of prepubertal children with mild asthma treated with inhaled beclomethasone dipropionate

Am J Respir Crit Care Med